SPA Standards Review Reporting Form

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Please email us here if needed: ethics@sacredplantalliance.org.

Currently this email reaches Brian Anderson, Allison Hoots, Isaac Meadow, and Beth Topczewski. Please see FAQ for more info or individual contact info for these individuals.

This form allows individuals to report harm or potential harm done by a Member church of Sacred Plant Alliance (SPA) to SPA Leadership. If the allegations are found to be in violation of SPA's Member Standards (Code of Ethics + Standards of Conduct), SPA will seek to support the Church in repair if appropriate and making necessary changes to prevent similar situations in the future.

Our intention with this process is to offer harmed parties a place to be heard and to support all Member churches in creating safer spaces for their congregants, in line with SPA's Member Standards.

SPA takes allegations of misconduct by our Members very seriously. We also recognize that it may feel intimidating, unsafe, or exhausting to engage with an ethics body, and we sincerely appreciate that you shared this information with us.

We also recognize that when a person has been harmed, it can be feel intimidating, unsafe, or exhausting to engage in an ethics process. We appreciate your time and emotional energy in making this report. You are always welcome to ask questions and ask for what you need in this process.

Before submitting this form, please read the FAQ on our Standards Review Process.

The FAQ will answer many questions on what will happen if you submit a report, who will receive your report, and what confidentiality you can expect from us.

Please note:

1. We strive to protect confidentiality, but we cannot guarantee the confidentiality of any information received through this process. For details on our confidentiality policy, please see Standards Review Process Policy, section IV.

2. Any written report will be received and read by all members of the Standards Review Committee. Current members of the Committee can be found in the FAQ linked above.

3. The Standards Review Process is not a legal process, or a substitute for legal action. We do not offer legal advice. We recommend you speak with an attorney about your options.

4. We will follow up with you within 10 business days to schedule a follow-up conversation.

Thank you for helping to make our communities safer.

Email *

Your Information

Note: If you prefer, you can file a report anonymously. However, please note that our capacity to take action on anonymous reports is limited. Please see Standards Review Process Policy for further information. If you have confidentiality concerns consider reaching out to us at ethics@sacredplantalliance.org to find a way forward.

This form collects your emails. If you wish to remain anonymous, you can open an email account under an assumed name. We are asking for your email so we can respond to you and provide you a copy of this form after you submit it.

Your telephone number

Your relationship to the affected person *

Check all that apply

I was directly affected or harmed by the events I am reporting

I was not directly affected, but I witnessed the events or they were reported to me

I am a family member, friend, or acquaintance of the person directly affected

I may have caused harm to another individual

Other:

Required

Your relationship to the community where the events took place *

Check all that apply

I am a Participant in the community where events took place

I am an Assistant in the community where events took place

I am a spiritual/ceremonial Leader in the community where events took place

I am an employee, Board member, or other Leader in the community where events took place

I do not have a connection to the community where events took place

Other:

Required

Details on Affected Person

This section asks for more details on the person(s) who were directly harmed or affected by the incident that is being reported.

Identifying details of Affected Persons

If you were a witness to these events, or heard about them from someone else, please share the name(s) of all individuals you believe were directly affected or harmed. Please include identifying information like age and gender identity as well.

If you are the affected person, please share your age and gender identity.

Contact Information for Affected Persons

Please provide contact information (email & phone) for the person(s) directly affected by this event, if not you. If SPA initiates an investigation in response to this report, we may reach out to them and invite their participation.

Details on Respondent(s) & Community

This section asks for more details about the Respondent(s) (the person or people you believe caused harm or violated SPA Member Standards) and the church or community where the incidents being reported took place.

Name & location of church or community where the incident took place. *

If known, name and contact information of a representative of the church or community where the incident took place

Note: We will not reach out to this person until a formal Standards Review Process is underway. We will discuss expectations about the process with you during your first interview. If you have concerns please reach out at ethics@sacredplantalliance.org

Name of Respondent(s) (the person who you believe caused harm) *

Known alias(es) or "medicine name(s)" of Respondent

Contact information for Respondent(s), if known

Identifying details of Respondent(s)

Details that may help us identify the Respondent(s), e.g. approximate age, gender, etc.

Event Details

This section asks for more information about the specific event or events you are reporting

Approximate date of incident(s), if known *

Write "unknown" or give a best guess if you don't know.

What happened? *

Please be as specific as you feel comfortable. Think who, what, where, when, how. Please include, if known, whether sacrament was involved and what kind, whether emergency services or law enforcement have been involved, any healthcare referrals that have been made. You can report additional details during our follow-up conversation as well.

When did the event(s) being reported take place?

Before the Ceremony

During the Ceremony

Immediately after the Ceremony (same day or night)

During an extended retreat

Well after the Ceremony or Retreat (days to months)

Other:

Previous Attempts at Addressing Harm

Please share details about any previous attempts to address the harm from this incident.

Have you communicated your concern to a ceremony leader, assistant, or another representative of the church/community? *

Note: We understand that in cases of harm, it may not always be possible to report or that people may act in confusing or incongruous ways. The purpose of this question is to gather context for the overall situation, not to assess the credibility of your report.

Yes

If you answered yes above, please describe what happened.

Have you taken any other steps to address the harm done? To your knowledge, has anyone else attempted to address this harm, and what happened? *

What would be your ideal outcome from this report?

A copy of your responses will be emailed to the address you provided.

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